TV Therapy: Separating Fact From Fiction

Source: Courtesy of Michael De Lazzer

If therapists seen on TV and in movies represented most real-life therapists, I’d never have become one! Granted, there are a few semi-realistic or positive portrayals on screen. But with so many inaccurate representations, how's the public supposed to know the difference between normal and abnormal?

For Example

Recently, I watched the Netflix series, "Gypsy." It freaked me out! Naomi Watts’s character, psychologist Dr. Jean Holloway, keeps talking about confidentiality (e.g., “I can’t share this or that because of confidentiality”-type statements). Yet she nonchalantly hands over her full treatment notes to an official. Therapists can’t just willy-nilly do that! They typically need the patient's permission or a court order. Additionally, she reveals details from sessions to all sorts of people. Heck, she goes out and meets the people her patients tell her about—even sleeps with one. She also seems to try to keep her patients dependent on her, lies to them and her colleagues about them, and falsifies notes. Oh my goodness, no!

That’s not how it should work. Yet those unfamiliar with therapy could see those incidences as the norm—or at least possible to experience. In reality, if Dr. Jean Holloway was reported for any one of those illegal or unethical behaviors, she could face disciplinary actions and possibly lose her license.

On "Billions," meetings with psychiatrist Dr. Wendy Rhoades sometimes occur with little to no privacy. Co-workers occasionally barge in mid-exchange. And, maybe that’s normal for a Wall Street “performance coach,” which an online deep dive into the character revealed as her second title. However, those are not typical to experience and generally not conducive to good “therapy.” (A word to the wise: If people watch, listen to, or join your psychotherapy sessions without your permission, please re-evaluate that professional relationship.)

In the original "In Treatment," the character Dr. Paul Weston begins well enough. Then, his therapeutic boundaries blur. For example, he pet-sits a child patient’s turtle. It creates a dual role, distinct from therapy, that could harm the therapeutic process. Like, what if the pet died? That would likely derail the child’s treatment.

Eventually, Dr. Weston’s boundaries go really off the rails. The clearest example? He sleeps with his patient. And although many television series include sex between a therapist and their patient, that’s an egregious abuse of the therapist’s power. A practitioner can lose their license for doing that. It’s not appropriate or ethical, and, in many states, it’s illegal.

“But It’s Just Entertainment”

I understand that therapists are depicted sensationally and incorrectly “for entertainment purposes.” Yes, it’s “pretend.” However, I worry that it confuses the public, possibly preventing help-seeking. Oddly, when I’ve presented this concern to colleagues, I often hear, “But it’s just entertainment” (as if I’m a party pooper!).

It’s not “just entertainment.” Though there are few applicable studies, a 2014 research article confirms that television portrayals influence viewers' perceptions of professionals, fields, procedures, self-stigma, society, and, yes, help-seeking. Negative, unethical, and inaccurate accounts of therapy on screen can contribute to people avoiding help. And that makes me wish TV shows and movies had to post disclaimers such as these:

Contrary to what you just witnessed

1. Ethical therapy does not include sex.
2. Ethical therapists do not intentionally pursue forming social relationships with you, your friends, or your family.
3. Unless you give permission (or maybe if it’s life-and-death urgent), ethical therapists do not share your private information with their—or your—friends and family.
4. Ethical therapists do not exploit you.

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Why Media Portrayals Matter

Therapy isn’t like other healing practices. For example, most people understand the role of real-life surgeons. Even if portrayed wrongly or unscrupulously on screen, the public’s expectations of surgical doctors won’t likely change. Therapy, on the other hand, is less known, understood, or defined in real life (let alone on TV and in film).

Therapy occurs behind closed doors and is personal—dealing with mental illness, trauma, existential concerns, relationship problems, and other private issues. No matter what therapeutic philosophies a therapist relies on to help the patient reach their goals, it’s a vulnerable process for the patient. It requires trust in their therapist or, at the very least, the therapeutic process. So I ask you: Why would the public have faith in either if they repeatedly see dishonest, exploitative, unethical, law-breaking, exceedingly emotional, and boundaryless therapists represented in the media?

A Bummer State of Therapy on Screen

I'm in the middle of watching "The Patient" now, a show that smashes the sensationalized traditional plot of therapist harming patient. In this thriller series, the patient kidnaps the therapist to get the help he believes he needs. (Yikes!)

Despite the horrifying, scary, and abnormal circumstances, I feel relieved to have seen Steve Carell's character, Dr. Alan Strauss, provide some of the more ethical therapy I've seen in a series: patient-focused, goal-driven, and discussing ethical boundaries and therapeutic approaches along the way. He does so even while working under incredible duress—he’s chained to a bed and forced to provide treatment.

The bottom line is this: A good therapist will intensely listen and attune to your best interest while helping you explore your thoughts, behaviors, and feelings. A good therapist will help you grow and meet your therapy goals. A good therapist will honor their laws and ethics.

Call to Action

Perhaps you’re thinking of starting therapy, yet the main experience you've had with it has been watching it in a series or movie. If so, reach out to a therapist. Pose questions. You’re more than welcome to ask about what you saw on the screen that felt uncomfortable, harmful, or quizzical. For example, “I saw X on the show Y. Is that normal in therapy?”

Unfortunately, a good therapist is often not what you see on television and in films. Please don't let that stop you from getting the support you want or need. You can put as much faith in having an on-screen therapist represent actual therapy as you do Meredith Grey actually performing surgery.

Copyright 2022 Alli Spotts-De Lazzer